There are no clear indications for the best choice of anti-seizure medications to control brain tumor related epilepsy. In vitro studies have shown an antitumoral effect of Levetiracetam and Lacosamide on glioblastoma IDH-wild type. This study investigates whether the use of levetiracetam and/or lacosamide impacts survival rates. The secondary aim was to evaluate the efficacy of both ASMs in controlling seizures. In this observational retrospective single-cohort study, patients underwent chemoradiation protocol after GBM surgery. They were grouped as follows: (1) use of levetiracetam, (2) use of lacosamide, (3) simultaneous use of levetiracetam and lacosamide, (4) no ASM usage. Survival curves were plotted using the Kaplan-Meier method coupled with a log-rank test for difference assesments. To evaluate the pharmacological efficacy of post-operative seizure control, a negative binomial regression was conducted. The study included 272 patients, 174 of which underwent adjuvant chemoradiation treatment. Patients without ASM therapy had a non-significant longer median OS (compared to the other groups (log-rank = 0.37). The IRR of seizure relapse was 2.57 (p = 0.007) times higher in lacosamide users, and MGMT promoter methylation demonstrated a protective effect against postoperative seizure onset (p = 0.05), regardless of the aforementioned confounding factors. In patients diagnosed with GBM IDH-WT undergoing chemoradiation therapy, the use of levetiracetam or lacosamide for controlling BTRE does not seem to modify survival. Lacosamide users exhibited a higher IRR of postoperative seizures compared to levetiracetam users, and MGMT promoter methylation appears to be a protective factor.

Gliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literature, there is not a clear consensus on the best approach in terms of safety and efficacy. The purpose of this study is to evaluate the effectiveness of these approaches and to analyze prognostic factors on the natural history of insular gliomas. Patients with newly diagnosed high-grade insular gliomas who underwent surgery between January 2019 and June 2024 were analyzed. The series was analyzed according to the classification of Berger–Sanai and Yaşargil. The Karnofsky performance score (KPS), extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were considered the outcome measures. A total of 58 primary high-grade insular glioma patients were enrolled in this study. The IDH mutation was found in 13/58 (22.4%); specifically, 3/13 (23.1%) were grade 4, and 10/13 (76.9%) were grade 3. Furthermore, 40/58 patients (69%) underwent gross total resection (GTR), 15 patients (26%) subtotal resection, and 3 patients (5%) partial resection. Middle cerebral artery encasement negatively affected the OS. GTR, radiotherapy, KPS, and autonomous deambulation at a month after surgery positively affected the OS. The surgical approach used was transsylvian and transcortical in 11 and 47 cases, respectively. The comparison between the two different approaches did not display differences in terms of neurological deficits and OS (p > 0.05). The transcortical approach was related to the greater achievement of GTR (p = 0.031). According to the Berger–Sanai classification, the transcortical approach has higher EOR and postoperative KPS when the lesion is in zone III-IV (p = 0.029). Greater resection of insular gliomas can be achieved with an acceptable morbidity profile and is predictive of improved OS. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles. The transcortical approach with intraoperative mapping is more favorable for achieving greater EOR, particularly in gliomas within the inferior border of the Sylvian fissure.

Background: Porous titanium cages have emerged as a promising alternative to traditional interbody materials in anterior cervical discectomy and fusion (ACDF), potentially enhancing osteointegration while maintaining mechanical stability. This multicenter study evaluates clinical and radiological outcomes following stand-alone ACDF using 3D-printed porous titanium cages. Methods: This retrospective observational study included 120 patients (mean age 54.8 years) who underwent stand-alone ACDF across three tertiary spine centers. Clinical outcomes were assessed using the Numerical Rating Scale (NRS) and Short Form-12 (SF-12). Radiological outcomes at 12 months included fusion, subsidence, migration, and sagittal alignment parameters. Fusion assessment at 12 months was performed using CT or dynamic flexion/extension radiographs. Results: At 12 months, interbody fusion was achieved in 106 patients (88.3%; 95% CI: 81.4%-92.9%). NRS scores significantly improved (mean reduction 4.2 points; p < 0.001), while SF-12 showed no significant change. Cage subsidence occurred in 7 patients (5.8%), with no cases of migration. Cervical sagittal alignment parameters remained stable over time, with no significant differences after correction for multiple comparisons. No significant associations were identified between preoperative variables and adverse radiological outcomes. Conclusions: Stand-alone ACDF with porous titanium cages is associated with high fusion rates, significant pain reduction, and low complication rates at 1 year. These findings support the use of porous titanium cages as a viable option in non-plating cervical fusion strategies, although further comparative studies are warranted to better define their relative performance. Clinical trial number: Not applicable.

Purpose: To compare clinical and radiological outcomes of ACDF performed using stand-alone 3D-printed porous titanium cages versus anchored polyetheretherketone (PEEK) interbody cages in patients with degenerative cervical spine disease. Methods: This multicenter retrospective study included consecutive adult patients who underwent single- or two-level ACDF between January 2020 and October 2024. Patients were treated with either stand-alone porous titanium cages or anchored zero-profile PEEK cages. Clinical outcomes were assessed using the NRS and the SF-12 questionnaire. Radiological outcomes included intersomatic fusion, cage subsidence, and sagittal alignment parameters. Fusion was evaluated on static cervical radiographs at 12 months. Complications and revision surgeries were recorded. Results: A total of 265 patients were included (121 stand-alone; 144 anchored). Baseline demographic and clinical characteristics were comparable between groups. Operative time was significantly shorter in the stand-alone group (85 vs. 112 min). Both groups showed significant postoperative improvement in pain and functional scores. The magnitude of pain reduction was greater in the stand-alone cohort, while SF-12 improvement was comparable. Fusion rates (88.4% vs. 92.3%), subsidence rates (5.7% vs. 4.1%), complication rates, and sagittal alignment parameters did not differ significantly between groups. Osteoporosis was the only factor associated with an increased risk of cage subsidence. Conclusion: In this multicenter study, stand-alone 3D-printed porous titanium cages achieved clinical and radiological outcomes comparable to anchored PEEK cages in ACDF, with shorter operative times, preserved sagittal alignment, and similar complication, fusion, and subsidence rates. These findings support their use as a safe and efficient alternative in appropriately selected patients.

Spontaneous spinal epidural haematoma (SSEH) is a rare neurosurgical emergency characterised by the accumulation of epidural blood in the absence of trauma. Near-holocord haematoma extension is exceptionally uncommon and poses significant challenges to surgical management. A man in the 40s presented with the sudden onset of low back pain, flaccid paraplegia, urinary retention and hypertension. MRI revealed an extensive posterior epidural haematoma extending from the cervicothoracic junction to the sacrum, with maximal compression at the T11–L2 levels. Within 4 hours, the patient underwent a focused laminectomy (T12–L2, with undercutting of T11 and L3) and surgical evacuation of the clot via irrigation. Postoperative imaging confirmed satisfactory haematoma clearance. Full neurological function was restored. This case illustrates that rapid and targeted surgical decompression can result in complete neurological recovery, even in extensive cases of SSEH. Prompt MRI evaluation and early intervention remain critical to achieving optimal outcomes.